Dynamics of cerebral perfusion deficits after aneurysmal SAH – predictive value of early MTT for subsequent MTT deterioration - 14/11/17
, Julian Caspers a, b , Athanasios Konstandinou Petridis c , Bernd Turowski a , Rebecca May a Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
Background and purpose |
The pathogenesis of poor functional outcome after aneurysmal subarachnoid hemorrhage (aSAH) is not fully understood. Microcirculatory dysfunction, which can be indirectly measured by CT perfusion (CTP), is assumed to play a central role. We evaluated the predictive value of early changes in microcirculation for secondary critical perfusion changes.
Materials and methods |
Out of 351 consecutive aSAH patients, 166 patients with ≥1 CTP within 72h of ictus (early CTP) and ≥3 CTPs in total were included in the retrospective analysis (53.2±12.4years of age). Receiver-operating-characteristic (ROC) analysis was performed to identify the mean transit time (MTT) threshold in early CTP with the highest sensitivity and specificity for predicting secondary critical perfusion changes >72h after ictus. The odds ratio was calculated and the threshold for the highest odds ratio was determined.
Results |
Secondary critical perfusion changes were observed in 67/166 patients (40.4%). An early MTT 1.3 times the mean normal MTT could predict those changes with an odds ratio of 2.67 (sensitivity 67.2%, specificity 56.6%). Shifting the threshold to 1.26 times the mean normal MTT resulted in an odds ratio of 3.56 (sensitivity 79.1%, specificity 48.5%).
Conclusions |
Early MTT is predictive of secondary critical perfusion changes, which could have applications for neuromonitoring and treatment.
Le texte complet de cet article est disponible en PDF.Keywords : Subarachnoid hemorrhage, Computed tomography perfusion, Vasospasm, Delayed cerebral ischemia, Mean transit time
Abbreviations : aSAH, CT, CTP, DCI, GOS, MTT, rCBF, rCBV, ROC, ROI, SAH, SD, Tmax, WFNS
Plan
Vol 44 - N° 6
P. 371-376 - octobre 2017 Retour au numéro
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